Most patients don't have heart failure on an empty table, with good lighting all around and nothing to obstruct the paramedics who respond to the 911 call.
"My first cardiac arrest was in the backseat of a taxi cab," said Scott Kasper, Virtua Health's assistant vice president of emergency medical services.
Virtua's paramedic training program in South Jersey has long prepared students for the real world by sending them out into it. Now it's hoping to bring more real-world complexity to campus.
This fall, Virtua's paramedic science program - run at Camden County College since 1997 - will move one county north, to Rowan College at Burlington County. The community college will open an advanced simulation space for the two-year program, Kasper said.
"Today, when we bring our students into the skills lab to learn how to start an IV or to learn how to intubate, they're essentially doing it in a classroom with mannequins on a table," Kasper said. "What we're going to build at Rowan College at Burlington County are labs that will resemble, if you can imagine, a bathroom . . . driver's side of an automobile . . . a restaurant."
Until recently, Virtua had been the sole provider of paramedic services in Camden and Burlington Counties. Its paramedic science program at Camden County College, which currently has about 75 students, trains students for health-care systems across the region.
Virtua officials tout a certification exam pass rate of more than 90 percent for students' first attempts. The remainder pass the test on subsequent tries.
"I am glad to see our relationship with Virtua strengthen as we begin the paramedic science program," Paul Drayton, president of Rowan College at Burlington County, said in a statement.
The two-year Virtua program takes place over six consecutive semesters, and is designed for existing emergency medical technicians who want to get advanced training to move from ambulances to paramedic units.
There are about 400 "classroom" hours taught online, interspersed with 700 hands-on hours, which include weekly sessions in skill-building labs, clinical rotations in hospitals, and a capstone "field internship." Topics covered include trauma care, pharmacology, and obstetrics and neonatology.
"It is an intense amount of training, but it's pretty well spread out and organized, which is the most important thing," said Ash Gomer, a Virtua paramedic, who went through the program from 2008 through 2010.
"One week you're learning it, later that week or early the next week you're actually performing the skills you're learning. So, by the time you hit the street, you're actually pretty comfortable as far as training and patient care," Gomer said.
What they're less prepared for is the real-world unpredictability. Experience matters, Gomer said, describing the importance of the field internship.
"There's obviously a difference between the students and the seasoned paramedics - the seasoned paramedics had their routines," Gomer said. "Everything's muscle memory to them."
Virtua has few competitors locally; other paramedic training programs in New Jersey include Bergen Community College, Union County College, and Ocean County College.
"That's one of the reasons why we believe this move to RCBC is advantageous, because it really puts our program in a more central location," Kasper said, "so that the entire region - really, the entire state - may be able to take advantage of the program."
In Camden, Cooper University Hospital last month took over emergency medical services from Virtua, part of a political and legal fight that is ongoing.
Cooper doesn't run a program to train new paramedics, so it will continue to hire from education programs, including Virtua.
Cooper's focus will be on continuing training for its paramedics, keeping them up-to-date, said Gerard Carroll, Cooper's EMS medical director and an attending physician in its emergency medicine department.
Paramedics often respond to the same types of calls over and over, Carroll said. Some lifesaving skills may be rarely used, getting rusty until suddenly they are needed.
"It's a lot of responsibility for our guys to carry without ongoing education," said Carroll, who spent 15 years in the field, first as an EMT and then as a paramedic.
The Virtua program aims to prepare its graduates to better bear that responsibility from the start.
"I don't think it should be understated that when you make the transition from being an EMT to being a paramedic, the responsibility is awesome," Kasper said. "And I don't mean awesome by great, I mean awesome by the power of the responsibility that you have."